Diagnosis and Management of Genital Ulcers.
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Date
2013-11
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Abstract
Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious
causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections,
and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also
lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests
should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing
for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi
in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers.
The first episode of herpes simplex virus infection is usually treated with seven to 10 days of oral acyclovir (five days for
recurrent episodes). Famciclovir and valacyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine
is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of
intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis
are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges
from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for
ulcers caused by Behçet syndrome.
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Keywords
Herpes simplex, syphilis, genital ulcers, sexual trauma, oral acyclovir, penicillin G benzathine, doxycycline
Citation
Roett Michelle A, Mayor Mejebi T, Uduhiri Kelechi A. Diagnosis and Management of Genital Ulcers. Indian Journal of Clinical Practice. 2013 Nov; 24(6): 507-515.